Diabetes mellitus and COVID-19: reciprocal relationship

Authors: Martin Jankovský;  Peter Jackuliak;  Magdaléna Kovářová;  Juraj Payer
Authors‘ workplace: V. interná klinika LF UK a UNB, Nemocnica Ružinov, Bratislava
Published in: Forum Diab 2022; 11(1): 31-34


COVID-19 is a disease that has significantly negatively affected the morbidity and mortality of our patients with chronic diseases. Diabetes mellitus is considered a risk factor for infection, severe course but also a higher risk of patient death. On the other hand, COVID-19 has an effect on the development of type 1 or type 2 diabetes mellitus and also in the future mostly negatively affects our patients with diabetes mellitus. The article presents an overview of the findings of the mutual impact of DM and COVID-19.


diabetes – morbidity – mortality – COVID-19


1. Ghebreyesus TA. WHO Director-General’s opening remarks at the media briefing on COVID-19–11 March 2020. World Health Organization, 2020, 11 March 2020. Dostupné z WWW: <https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarksat-the-media-briefing-on-covid-19---11-march-2020>.
2. Zhou P, Yang XL, Wang XG et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature 2020; 579(7798): 270–273. Dostupné z DOI: <http://dx.doi.org/10.1038/s41586–020–2012–7>.
3. Zhang J, Dong X, Cao YY et al. Clinical characteristics of 140 patients infected with SARS‐CoV‐2 in Wuhan, China. Allergy 2020; 75(7):1730–1741. Dostupné z DOI: <http://dx.doi.org/10.1111/all.14238>.
4. Wolf D, Nee S, Hickey NS et al. Risk factors for Covid-19 severity and fatality: a structured literature review. Infection 2021; 49(1): 15–28. Dostupné z DOI: <http://dx.doi.org/10.1007/s15010–020–01509–1>.
5. Fadini GP, Morieri ML, Longato E et al. Prevalence and impact of diabetes among people infected with SARS-CoV-2. J Endocrinol Invest 2020;43(6): 867–869. Dostupné z DOI: <http://dx.doi.org/10.1007/s40618–020–01236>.
6. Berbudi A, Rahmadika N, Tjahjadi AI et al. Type 2 diabetes and its impact on the immune system. Curr Diabetes Rev 2020; 16(5): 442–449. Dostupné z DOI: <http://dx.doi.org/10.2174/1573399815666191024085838>.
7. Delamaire M, Maugendre D, Moreno MC et al. Impaired leucocyte functions in diabetic patients. Diabet Med 1997; 14(1): 29–34. Dostupné z DOI: <http://dx.doi.org/10.1002/(SICI)1096–9136(199701)14:1<29::AIDDIA300>3.0.CO;2-V>.
8. Lederman MM, Schiffman G, Rodman HM. Pneumococcal immunization in adult diabetics. Diabetes 1981; 30(2): 119–121. Dostupné z DOI: <http://dx.doi.org/10.2337/diab.30.2.119>.
9. Memish ZA, Perlman S, Van Kerkhove MD et al. Middle East respiratory syndrome. Lancet 2020; 395(10229): 1063–1077. Dostupné z DOI: <http://dx.doi.org/10.1016/S0140–6736(19)33221–0>.
10. Dunn EJ, Grant PJ. Type 2 diabetes: an atherothrombotic syndrome. Curr Mol Med 2005; 5(3): 323–332. Dostupné z DOI: <http://dx.doi.org/10.2174/1566524053766059>.
11. Yang JK, Feng Y, Yuan MY et al. Plasma glucose levels and diabetes are independent predictors for mortality and morbidity in patients with SARS. Diabet Med 2006; 23(6): 623–628. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1464–5491.2006.01861.x>.
12. Wu C, Yanping Cai YC et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med 2020; 180(7): 934–943. Dostupné z DOI: <http://dx.doi.org/10.1001/jamainternmed.2020.0994>.
13. Guo W, Li M, Dong Y et al. Diabetes is a risk factor for the progression and prognosis of COVID‐19. Diabetes MetabRes Res Rev 2020; e3319. Dostupné z DOI: <http://dx.doi.org/10.1002/dmrr.3319>
14. Geerlings SE, Hoepelman AI. Immune dysfunction in patients with diabetes mellitus (DM). FEMS Immunol Med Microbiol 1999; 26(3–4): 259–265. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1574–695X.1999.tb01397.x>.
15. Zhu L, She ZG, Cheng X et al. Association of blood glucose control and outcomes in patients with COVID-19 and pre-existing type 2 diabetes. Cell Metab 2020; 31(6): 1068–1077.e3. Dostupné z DOI: <http://dx.doi.org/10.1016/j.cmet.2020.04.021>.
16. Philips BJ, Meguer JX, Redman J et al. Factors determining the appearance of glucose in upper and lower respiratory tract secretions. Intensive Care Med 2003; 29(12): 2204–2210. Dostupné z DOI: <http://dx.doi.org/10.1007/s00134–003–1961–2>.
17. Zhang Y, Ding X, Hua B et al. Real-world use of ACEI/ARB in diabetic hypertensive patients before the initial diagnosis of obstructive coronary artery disease: patient characteristics and long-term follow-up outcome. J Transl Med 2020; 18(1): 150. Dostupné z DOI: <http:/10.1186/s12967–020–02314-y>.
18. Liu M, Wang T, Zhou Y et al. Potential role of ACE2 in coronavirus disease 2019 (COVID-19) prevention and management. J Transl Int Med 2020; 8(1): 9–19. Dostupné z DOI: <http://dx.doi.org/10.2478/jtim-2020–0003>.
19. Chamsi-Pasha MA, Shao Z, Tang WH. Angiotensin-converting enzyme 2 as a therapeutic target for heart failure. Curr Heart Fail Rep 2014: 11(1): 58–63. Dostupné z DOI: <http://dx.doi.org/10.1007/s11897–013–0178–0>.
20. Ding Y, He L, Zhang Q et al. Organ distribution of severe acute respiratory syndrome (SARS) associated coronavirus (SARS‐CoV) in SARS patients: implications for pathogenesis and virus transmission pathways. J Pathol 2004; 203(2): 622–630. Dostupné z DOI: <http://dx.doi.org/10.1002/path.1560>.
21. Zhang H, Penninger JM, Li Y et al. Angiotensin-converting enzyme 2 (ACE2) as a SARS-CoV-2 receptor: molecular mechanisms and potential therapeutic target. Intensive Care Med 2020; 46(4): 586–590. Dostupné z DOI: <http://dx.doi.org/10.1007/s00134–020–05985–9>.
22. Zhou P, Xing-Lou Yang XL, Wang XG et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature 2020; 579(7798): 270–273. Dostupné z DOI: <http://dx.doi.org/10.1038/s41586–020–2012–7>.
23. Hoffmann M, Kleine-Weber H, Schroeder S et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell 2020; 181(2): 271–280.e8. Dostupné z DOI: <http://dx.doi.org/10.1016/j.cell.2020.02.052>.
24. Heurich A, Hofmann-Winkler H, Gierer S et al. TMPRSS2 and ADAM17 cleave ACE2 differentially and only proteolysis by TMPRSS2 augments entry driven by the severe acute respiratory syndrome coronavirus spike protein. J Virol 2014; 88(2): 1293–1307. Dostupné z DOI: <http://dx.doi.org/10.1128/JVI.02202–13>.
25. Dalan R, Bornstein SR, El-Armouche A et al. The ACE-2 in COVID-19: foe or friend?. Horm Metab Res 2020; 52(5): 257–263. Dostupné z DOI: <http://dx.doi.org/10.1055/a-1155–0501>.
26. Liu F, Long X, Zhang B et al. ACE2 expression in pancreas may cause pancreatic damage after SARS-CoV-2 infection. Clin Gastroenterol Hepatol 2020; 18(9): 2128–2130.e2. Dostupné z DOI: <http://dx.doi.org/10.1016/j.cgh.2020.04.040> .
27. Bornstein SR, Rubino F, Khunti K et al. Practical recommendations for the management of diabetes in patients with COVID-19. Lancet Diabetes Endocrinol 2020; 8(6): 546–550. Dostupné z DOI: <http://dx.doi.org/10.1016/S2213–8587(20)30152–2>.
28. Li H, Shenghua Tian S, Ting Chen T et al. Newly diagnosed diabetes is associated with a higher risk of mortality than known diabetes in hospitalized patients with COVID‐19. Diabetes Obes Metab 2020; 22(10): 1897–1906. Dostupné z DOI: <http://dx.doi.org/10.1111/dom.14099>.
29. Gierer S, Bertram S, Kaup F et al. The spike protein of the emerging betacoronavirus EMC uses a novel coronavirus receptor for entry, can be activated by TMPRSS2, and is targeted by neutralizing antibodies. J Virol 2013; 87(10): 5502–5511. Dostupné z DOI: <http://dx.doi.org/10.1128/JVI.00128–13>.
30. Valencia I, Peiró C, Lorenzo O et al. DPP4 and ACE2 in diabetes and COVID-19: therapeutic targets for cardiovascular complications?. Front Pharmacol 2020; 11: 1161. <Dostupné z DOI: http://dx.doi.org/10.3389/fphar.2020.01161>.
31. Romacho T, Vallejo S, Villalobos LA et al. Soluble dipeptidyl peptidase-4 induces microvascular endothelial dysfunction through proteinase-activated receptor-2 and thromboxane A2 release. J Hypertens 2016; 34(5): 869–876. Dostupné z DOI: <http://dx.doi.org/10.1097/HJH.0000000000000886>.

Diabetology Endocrinology Internal medicine
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account